Health Care Complaints Commission v Wardle

The Hearing

1. The HCCC filed five volumes of evidentiary material, including a peer expert report by Dr Timothy Keogh, a health assessment report by Dr Samuels and voluminous email correspondence between the practitioner and Patient B. Patient A's clinical notes from the practitioner's treatment were in evidence but Patient B's notes were not; her file was identified by Mr Wardle as missing in late 2016 after it was requested by the HCCC. Patient B made two written statements, dated October 2016 and 12 January 2018. The majority of the claims concerning alleged inappropriate remarks and touching were contained in the second of these statements.
2. Dr Keogh and Dr Samuels gave oral evidence, as did Patient B. Dr Keogh appeared by telephone and Patient B by video link.
3. The practitioner was self-represented at the hearing. Mr Wardle filed a formal reply to the complaint dated 20 September 2019 but did not comply with any of the other directions for the filing and exchange of evidence. On the morning of the hearing Mr Wardle tendered two bundles of materials, comprising a revised response to the complaint, excerpts of various Australian Psychological Society (APS) guidelines, copies of some screening and assessment tools which he stated he uses as part of his customary practice, correspondence between Patient A and the HCCC, and some file notes which the HCCC had disclosed to the practitioner but not included in their evidence.
4. The Tribunal is mindful of the difficulties faced by unrepresented respondents in this jurisdiction and of its obligations under s 38(5) of the Civil and Administrative Tribunal Act 2013 (NSW). In light of these considerations, and of the respondent's patent distrust of the HCCC (and, at times, misunderstanding of its role and of relevant processes), the Tribunal afforded considerable latitude to the respondent in the conduct of his case. The two folders were admitted.
5. The Tribunal explained the processes and procedures of the disciplinary hearing to the respondent throughout proceedings and took steps to ensure that the legislative requirements and relevant precedential cases were known to him. Although facing a claim of impairment, the Tribunal determined that the respondent was competent to understand the case against him and to conduct his own case.
6. On the second day of the hearing, after having cross examined Patient B, the respondent sought to introduce a further bundle of evidence, containing seven statutory declarations from friends and family members, including Patient A, and two letters from health practitioners. The two letters were from his current supervisor and former GP, to the effect that the practitioner was not impaired and was fit to practise. The respondent was unequivocal that his intention in providing the seven statutory declarations was to discredit Patient B and to prevent the HCCC and Patient B from having the opportunity to consider this material in advance and respond to it.
7. The HCCC objected to the admission of all of the material, and also pointed out that many of the statutory declarations contained passages of identical or near identical text such that they could be given little if any weight. Mr Wardle acknowledged having provided some of the declarants with suggested text. It was also apparent to the Tribunal that much of the content in the declarations concerned the authors' belief in the truth of what Mr Wardle had told them about events with Patient B, and not first-hand knowledge of any factual matter in dispute.
8. Latitude to an unrepresented respondent must be balanced with the rules of procedural fairness, which apply to both parties, and the need to ensure that decisions are based on material that is relevant and logically probative: Sudath v Health Care Complaints Commission [2012] NSWCA 171; Lindsay v Health Care Complaints Commission [2010] NSWCA 194.
9. The Tribunal determined that the statement from Patient A and the two health practitioners were relevant to the Stage 1 proceedings and should be admitted if the authors were available for cross examination. The six other declarations were admitted for Stage 2 only as they were held to be in the nature of character references.
10. Patient A appeared by telephone and gave oral evidence as did Ms de Bakker, a clinical psychologist who has been supervising Mr Wardle for the past 18 months under the terms of the s 150 conditions. Despite Mr Wardle offering a time for availability of the other heath practitioner, he did not appear, and so his letter was excluded from the evidence.

The Complaints

1. Complaint 1 is that the personal and sexual relationship with Patient A involved failures to observe professional boundaries in that the practitioner commenced a social relationship with the patient after terminating the therapeutic relationship (particular 1), failed to provide appropriate care and treatment in that he failed to make reasonable arrangements for continuity of care after termination (particular 2), engaged in a sexual relationship from April 2016 (particular 3), and employed the patient from April 2016 (particular 4). The HCCC contends that Complaint 1 is unsatisfactory professional conduct under both limbs; that is, as conduct below the standard reasonably expected under s 139B(1)(a) and as improper or unethical conduct under s 139B(1)(l).
2. Complaint 2 is that the practitioner failed to make and keep adequate records of his consultations with Patient A in that he did not record any diagnostic formulation, treatment plan, the need for continuity of care, clinical justification for termination, did not provide and/or retain reports to the patient's GP and did not record any consultation with a more senior psychologist about the decision to terminate in order to pursue a social relationship. This complaint and Complaint 4 are said to amount to unsatisfactory professional conduct as being below the standard reasonably expected.
3. Complaint 3 concerns the practitioner's relationship with Patient B and contains a multitude of contested matters. Particular 1 is that the practitioner failed to observe proper professional boundaries during the therapeutic sessions in that he made a variety of sexualised remarks and also inappropriately touched the patient on various occasions. Particular 2 is that during the therapeutic relationship the practitioner visited Patient B's home uninvited and made a variety of sexualised remarks and also inappropriately touched the patient on some of those occasions, asked Patient B to help him move house and also visited her business premises uninvited. Particular 3 concerns the three aspects of the business relationship post termination. Particular 4 is that the practitioner failed to observe proper professional boundaries in that he became inappropriately involved with Patient B's financial affairs in that he acted as her creditor, recommended an accountant to her and then proceeded to send engagement documents to that accountant and meet with her and the accountant together. Particular 5 concerns failure to provide appropriate care and treatment in that he failed to make reasonable arrangements for continuity of care after termination. Particular 6 is that the practitioner failed to observe proper professional boundaries in that after termination, he insisted she give notice on her house and move in with him and another person, made a joint tenancy application, and then later did live together with a third person, and that during this time made further sexual remarks and inappropriate physical contact, socialised together and had access to her personal mail box. Particular 7 asserts a failure of professional boundaries in that Patient B worked in the practitioner's psychology practice after termination. As with Complaint 1, Complaint 3 is said to be both below the expected standard and improper and unethical.
4. Complaint 4 concerns the failure of the practitioner to make and keep clinical records in relation to Patient B in that: he did not keep her clinical file secure, did not attempt to reconstruct a summary and made errors in the reconstructed billing notes of sessions (particular 1) and did not provide reports to Patient B's referring GP (particular 2).
5. Complaint 5 is that the conduct amount to professional misconduct, both individually in Complaints 1 and 3, and cumulatively with Complaints 1-4.
6. Complaint 6 is that impairment arises from a depressive disorder and underlying personality vulnerability with marked narcissistic personality features.

The Issues

1. The practitioner acknowledged that a sexual relationship with Patient A occurred within two years of the therapeutic relationship and conceded that this is expressly proscribed by the Code of Ethics. He also acknowledged a number of other factual matters; namely that he had a social relationship with Patient A following termination, that she also worked for him in his private practice, and that he didn't consult with another psychologist about the relationship with Patient A. He also acknowledged the three business ventures with Patient B as laid out in Complaint 3.3, that he invoiced Patient B for payment concerning various items, and that he did suggest, and then send a letter of engagement to, an accountant on behalf of Patient B, make a joint tenancy application with Patient B, subsequently shared rented premises for a time with Patient B, introduced her to his friends, attended more than one function with her, and on one occasion hugged her.
2. Mr Wardle did not however concede the complaints in that he did not accept that his conduct amounted to unsatisfactory professional conduct or professional misconduct. In his September 2019 reply the practitioner rejected the peer expert criticism of his conduct as 'done from the basis of an unreal world, one model fits all, academic expectation of psychological treatment.' Mr Wardle contended that, There is no proven lack of adherence to definitive Code of Ethics obligations, just opinions of perceived departure from mythical expectations, due to a difference in working practice and philosophy. …there is no written clauses within the Code that definitively prohibit business or social relationships with former clients, no violations have been made, hence a finding of unprofessional conduct is unjust and unfair and will be based on opinion, of what I should have or not have done, rather than adherence to the Code or Law. (errors and emphasis in original)
3. Moreover Mr Wardle contended throughout the hearing that the therapeutic relationship was appropriately terminated in both cases in accordance with the patient's wishes and that he had acted at all times in their best interests. Nor did he accept any associated deficiency in his clinical record keeping, notwithstanding that he could not locate or produce Patient B's clinical file.
4. Mr Wardle's position was that he does not suffer from any impairment.
5. The major issues to be determined are:

• Did the practitioner fail to make reasonable arrangements for continuity of care of Patient A and B?
• Did the practitioner fail to make and keep adequate records concerning treatment of Patient A and B?
• Did the practitioner speak to and touch Patient B in various specified inappropriate ways: within the treatment context; at her home during the treatment period; and at their shared home after termination?
• Does the admitted and proved conduct justify a finding of unsatisfactory professional conduct or professional misconduct?
• Does the practitioner have an impairment within the meaning of the National Law?

Patient A

1. Mr Wardle's consistent position was that there was no impropriety in his termination of therapy with Patient A and subsequent social and employment relationship. In his written responses Mr Wardle stressed that this was because the termination was by agreement in order to 'pursue a mutual interest in collectibles'. In his view he had discharged his professional duties by offering Patient A a referral to another psychologist and accepting that she did not wish to see anyone else. In Mr Wardle's words, in his practice the patient is in 'the driver's seat' and he supports their self-determination.
2. In his oral testimony and submissions, Mr Wardle emphasised that Patient A had really been seeing him in relation to a concern that she was a hoarder and that, having mutually determined that Patient A was in fact a collector not a hoarder, Patient A felt completely resolved about her psychological issues and did not wish to see another psychologist.
3. Patient A's oral evidence was that she had decided by the third session that she was not actually a hoarder and that when therapy concluded she did not wish to take up a referral to another psychologist. However she gave a somewhat different account of the termination process as follows, By the last session we realised we had a fair amount in common… It was clear we liked each other. Alistair said we could be friends and I said that would be nice and he said if we were friends I couldn't come any more and I agreed. Later on he phoned and said it was totally up to me if I wanted to be friends and he left it totally up to me and I said yes I wanted to be friends.
4. While the practitioner denied that he had made personal revelations in the course of the five therapy sessions, we find that there must have been some level of inappropriate personal disclosure by him in order for Patient A to conclude that they had interests in common and that they 'liked each other'. Moreover Mr Wardle stated in oral evidence that he had formed the view by the fourth session that Patient A was continuing with therapy as a form of 'de facto social relationship' with him, and that he was aware of her view that a 'decent man is hard to find' at her age in a regional area, yet he continued to see her for a further session, did not address the issue of transference and did not seek any supervision on the issue from a more senior colleague. Instead the practitioner terminated in order to pursue a personal relationship.
5. Patient A's version is more consistent with the practitioner's letter to the HCCC on 2 November 2016 in which he stated: Due to our unique common interests, I noticed a friendship beginning to develop between us, such that a therapist/patient relationship was no longer possible. As soon as I noticed this, I explained to [Patient A] we could no longer maintain a therapeutic relationship if she wanted to pursue a social relationship. [Patient A] indicated she was [sic] wanted to pursue a social relationship.
6. We reject the practitioner's account of Patient A's therapy as being principally concerned with hoarding and as fully resolved within four sessions over a period of approximately five weeks. In addition to the above, such account is also inconsistent with the practitioner's clinical notes for Patient A which were in evidence.
7. At the bottom of one intake document, Patient A answered the question, 'What is the event(s) that has been bothering you?' with 'Myself, divorce, death of father, things that I do.' The practitioner administered a mood assessment intake questionnaire. In Dr Keogh's opinion, that assessment indicated Patient A to be vulnerable to depression as well as likely to have suffered from severe social phobia, generalised anxiety disorder and severe obsessive compulsive disorder. In tandem with the practitioner's notes, Dr Keogh's opinion was that Patient A 'could be considered to have long standing psychopathological difficulties and to have experienced recent life events that were likely to exacerbate these vulnerabilities.'
8. The notes of the first two sessions contain a lot of history. A number of statements recorded in the notes are clearly quotes from the patient. The practitioner's notes of the third session, dated 31 August 2015 commence with, 'Crying ever since yesterday - only 2 hours sleep last night' and continue a few lines later, 'Coming here - stirred up all the old stuff.'
9. There are one and a half pages of notes concerning the fourth session on 11 September 2015. This is the session in which the practitioner says he concluded that Patient A was attending as a way of pursuing a social relationship with him, and Patient A says she decided all of her issues were resolved. The practitioner also stated in oral evidence that by this session he had 'diagnosed' Patient A as a 'collector not a hoarder'. Nothing suggesting those observations or conclusions is recorded. Instead, in larger than average lettering is the remark, 'I feel like I'm heading for a collapse.' This is followed by three boxes across the page in which the practitioner appears to have categorised and listed Patient A's assets, their value and her share in them, amounting to several hundred thousand dollars. In oral evidence Patient A confirmed that the recorded descriptions and amounts reflected her assets at the time.
10. The fifth session, dated 25 September 2015 in which termination was apparently agreed, was also recorded in one and a half pages of notes. These notes make no reference to the termination discussion or decision, nor to the possibility of referral. The notes record that Patient A sold an asset the previous week (which she clarified in oral evidence was in addition to the ones listed in the earlier notes) for '$310K'. The notes also include the statements, 'Feel I'm always under pressure from someone' and 'physically, mentally and emotionally exhausted.'
11. In the above circumstances we reject the practitioner's view that he had discharged his professional duty by offering to make a referral. We find that he did not make an independent or adequate assessment of the patient's psychological needs. Moreover we find that the social relationship was clearly contemplated as a pathway to a future romantic relationship, such that the failure to refer was an even more acute failure of care.
12. This was not a therapeutic termination in the sense that it was not made based upon a professional assessment of the patient's needs and interests. We accept the opinion of Dr Keogh given in oral evidence that the professional failure of the practitioner was twofold, being in the management of the termination and in the continuity of care. The expert was strongly critical of these failures and we concur in this assessment.
13. The peer expert was critical of the practitioner's notes on Patient A for failing to record any indication of a diagnostic formulation, treatment plan, or any rationale or plan for termination.
14. Mr Wardle's response was to argue that there was no specific provision in the Code or Guidelines which required him to record a diagnosis. This response typified the approach of the practitioner, which was to constantly deflect from the question of his own independent judgment and professional responsibilities and assert that no specific 'rule' had been broken. The practitioner also noted repeatedly that his clinical notes were primarily for his own benefit as a memory aide and that he recorded what he thought was important at the time.
15. With respect, the practitioner's position misapprehends both the nature of professional responsibility and the role of clinical records. In oral evidence the peer expert clarified that 'diagnosis' encapsulates the performance of a professional assessment and formulation of a client's problems, regardless of which diagnostic tools are used, in order to then proceed to formulate and pursue a therapeutic intervention. The expert opinion was that the records did not reflect any such steps. Clinical records must be of a standard that enables another practitioner to understand the nature of the patient's treatment and to take over such treatment if needed. The records do not do this.
16. The practitioner also argued that the assessment documents he used were in fact a diagnosis and acted as 'de facto' treatment plans. We concur with the expert opinion that these documents were inadequate as they do not indicate the assessment made of the patient by the practitioner, and there was no indication of what the assessment instruments were used for, nor what interventions were pursued. Nor do those documents reflect the practitioner's oral account of the treatment of Patient A as being 'mostly' or 'really' about hoarding. We find that the practitioner's clinical records for Patient A clearly fall below the professional standard reasonably expected.
17. Mr Wardle's position was that he did not consult with a more senior colleague about his decision to terminate the therapeutic relationship with Patient A in order to pursue a social relationship because he had no doubts or concerns about this course of action. As with a number of elements of the complaint, Mr Wardle claimed that this particular was 'invalid' because there was 'no requirement in the Code that mandates that such a course of action MUST be taken.' (emphasis in original)
18. At no stage did Mr Wardle accept that there was a boundary crossing or professional failure on his part in employing Patient A to work at his psychology practice from April 2016 while she was in a romantic relationship with him and in circumstances where she had six months earlier been a patient at the very same practice. In the course of that work, Patient A had access to patient files and undertook tasks such as filling in and sending reports on patients to their referring practitioners. The respondent's position was that there was no express provision in the Code of Ethics proscribing such conduct.
19. The peer expert was strongly critical of this conduct on the basis that it did not adequately safeguard the patient's ongoing welfare, in that she could be exposed to distressing and/or confidential material about other patients. There was also the risk that other patients would experience concern about confidentiality. The Tribunal further notes that the fact that the practitioner and former patient were at the same time in a romantic relationship exacerbated the risk to patient confidentiality.
20. On the basis of the above findings, all of the particulars of Complaints 1 and 2 are found proved on the balance of probabilities, with one exception, addressed below.
21. The practitioner contended that he was not at fault in failing to provide a report to Patient A's referring general practitioner because Patient A had specifically requested he not do so, on the basis that she was changing to a different GP. Patient A also gave this account. Moreover Patient A had only attended five sessions and reports are provided under the Medicare Plan after six sessions. We accept this evidence and make no adverse finding on this particular alone (Complaint 2, part 1(e)).
22. Complaints 1 and 2 are made out to the required standard. We find that the conduct in Complaint 1 is both below the standard required and is improper and unethical in that the practitioner precipitously terminated a therapeutic relationship with a patient in order to pursue a personal relationship and did so without proper regard to her interests, a professional assessment of her therapeutic needs, and without seeking supervision. The ensuing sexual and employment relationship represent further boundary violations in which the practitioner placed his own needs and interests first and could not see the very real risk of confusion of roles, conflict of interest and potential harm. This conduct is of such inherent seriousness as to justify a finding of professional misconduct.

Patient B

1. Mr Wardle's position was that he had not transgressed any professional boundary or obligation in entering into the admitted personal and business relationship with Patient B shortly after terminating therapy. He believed that he had complied with all of his professional obligations towards Patient B; indeed, in cross examination he stated that he went 'above my obligations in my care of her. I provided her the highest level of care.'
2. It must be recollected that none of Patient B's clinical notes were in evidence. The peer expert was strongly critical of the practitioner's failure to keep Patient B's records, including any reports to her GP, and his failure to reconstruct notes once he was aware they were missing. The Tribunal concurs in this criticism, and notes further that while the practitioner eschewed any responsibility for the missing file, he saw no difficulty in the fact that both Patient A and Patient B having worked in the practice had been provided by him with access to it.
3. In evidence was a letter written by the practitioner on Patient B's behalf dated 2 September 2014, concerning a court application for an AVO against her former husband. This letter was provided by Patient B to the HCCC. It states, inter alia: [Patient B] came to see me [from April 2014] in a state of distress and depression following her husband [name] leaving her. [Patient B] has described numerous instances where [husband] has psychologically and emotionally abused her… [Patient B] has called for an appointment to see me as soon as possible after each instance of being approached by [husband]. [Patient B] has been in a state of extreme distress - crying and feeling afraid, overwhelmed and suicidal on each of these visits. [Patient B] displays all of the behaviours of someone who has been abused and lost all confidence in herself. [Patient B] is constantly fearful of being approached by [husband] and as a result goes out in public as little as possible. According to [Patient B], [husband] has consistently taken financial advantage of her… I am greatly concerned for [Patient B's] welfare and would class her as being at risk of becoming suicidal.
4. The letter concludes with the observation that Patient B has 'few friends' and 'little support'. This record attests to the practitioner's first-hand knowledge of the acuteness and complexity of Patient B's psychological and social conditions and her need for care.
5. Based on the acknowledged facts alone we find that the practitioner's conduct in relation to Patient B represent a grievous and prolonged dereliction of his professional responsibilities. The practitioner terminated the therapy of a patently vulnerable woman in order to pursue various business ventures with her, during the course of which he became completely enmeshed in all aspects of her finances and personal life. Within weeks of the termination he was exploring business ventures with her, and was drafting and sending business correspondence on her behalf. Within months the practitioner had sent Patient B to his accountant and also attended upon the accountant with her. He lent her money, claimed money from her for tasks he had undertaken, jointly applied for both residential and business premises with her and had a registered business name and joint bank account. On multiple occasions Patient B performed unpaid administrative work in Mr Wardle's psychology practice. She also holidayed with him and performed unpaid work on his investment property.
6. None of these actions were appropriate in the context of a recently terminated therapeutic relationship. This is particularly so given that Patient B was a psychologically vulnerable and socially isolated patient, who was, moreover, under the care of a new psychologist who had not been informed of the dual relationship.
7. On the basis of the practitioner's admissions and in light of the entirety of the evidence we are independently satisfied that particulars 3.3, 3.4 and 4.1(a) and (c) are proved. The Tribunal is satisfied that these uncontested matters are below the professional standard reasonably expected and that 3.3 and 3.4 are also improper and unethical. We find that the boundary violation involved in the blurred therapeutic, personal and business relationship is of such seriousness, and such repetition over the period of approximately 18 months, as to rise to the level of professional misconduct.
8. Some differences in the practitioner's and Patient B's parallel accounts of acknowledged events must be resolved in order to make findings on certain particulars, such as the failure to ensure continuity of care in circumstances in which Mr Wardle did refer Patient B to another psychologist as part of the termination process. The resolution of some differences in the accounts is also necessary to address the seriousness of the conduct.
9. The practitioner claims that it was Patient B's decision to terminate therapy in November 2014 after she asked him to restore some furniture for her in October 2014 and he explained to her that she had to decide whether she wanted him as a furniture restorer or a psychologist. The termination decision was taken in a single session in November. Mr Wardle made a verbal handover to another psychologist, Frank Bonneville, during a peer supervision session on 26 November 2014.
10. Dr Keogh was strongly critical of the management of the termination and continuity of care. Dr Keogh was of the view that this was a 'precipitous' termination decision in which Mr Wardle did not prioritise the patient's interests, did not consider the seriousness of her condition and did not seek supervision. This view was based on the practitioner's own account drawn from his written responses and account to the first s 150 proceeding.
11. In a letter to the HCCC dated 2 November 2016 Mr Wardle stated, 'I spoke to Frank and informed him that I was ceasing a therapeutic relationship with [Patient B] to enter into a non-related casual business relationship.' In the December 2016 s 150 proceeding Mr Wardle stated that he 'made the referral to Frank and explained the situation to him.' Later in the proceeding, when pressed by a panel member on whether he had consulted with a senior colleague about the dual relationship Mr Wardle stated, 'In terms of the business relationships with [Patient B], as I say, I spoke to Frank [Bonneville] as part of the referral process.'
12. Patient B's 2016 statement was to the effect that the social relationship was already on foot through the latter part of 2014, and that it was she who raised the 'ethical dilemma' of their friendship during therapy. Patient B's account is that she was advised by Mr Wardle to get a referral to another psychologist by stating that she and Mr Wardle 'knew each other from antique shows' and her shop, and that this was the reason she needed to stop seeing Mr Wardle.
13. In her written statement Patient B describes this as 'it felt like our terrible little secret.' She first saw Mr Bonneville from 7 January 2015 based on a referral from her GP dated 27 November 2014. Patient B stated that she did not discuss her personal relationship with Mr Wardle with her GP or in her consultations with Mr Bonneville.
14. Mr Bonneville stated in a letter to the HCCC that he recalled a peer meeting with Mr Wardle on 26 November 2014 in which Mr Wardle thanked him for accepting Patient B and as 'explaining that they have antique shops near each other.' Nothing in Mr Bonneville's recollection or the extracts of records he provided indicates that either Mr Wardle or Patient B informed him that they had an on-going personal relationship or business relationship.
15. We find that Mr Wardle instructed Patient B to misrepresent the nature of their on-going non-therapeutic relationship to her treating practitioners, and that he himself did not disclose the on-going relationship. In such circumstances any referral made by Mr Wardle could not be an adequate step to ensure continuity of care because the other practitioner/s did not know the real circumstances of the patient and so were prevented from being able to offer her informed and impartial advice or assistance concerning those circumstances. Particular 3.5 is made out.
16. The practitioner presented the business relationship as one in which he 'helped' Patient B, and in closing submissions claimed that he had contributed hundreds, if not thousands, of hours of pro bono business development work and advice to her.
17. In her 2016 statement Patient B says that during the therapy she discussed her financial problems and antique business and that through this process she, had begun to see Alistair as my financial advisor as well as my emotional and mental health counsellor. I had begun to rely on his advice heavily….There was no particular point in time when I felt that Alistair had become my friend rather than my psychologist.
18. The above account of Patient B's reliance on and deference to Mr Wardle's views on her financial affairs is in keeping with the other evidence, including an email drafted and sent by Mr Wardle on 9 December 2014 on Patient B's behalf terminating a commercial lease she held. In an email dated 26 April 2015 from Patient B to the practitioner, she states that she is planning to deliver a requested meal to him, and expresses gratitude to him, adding, I know that the scales are tipped out of balance in this new relationship that we are trying to define. I am in unchartered territory but am feeling very out of sorts with it and get the feeling that you may be as well. I am sensitive to owing you money and imposing on your time. I am trying not to impose on you or call you much or cry on your shoulder but I feel that I seem to be failing in that. You too have the burden of a divorce and suffering. I realize you are trying to start a new life of your own and do your own things, never enough time and then the burden of all of us broken toys. I have and continue to impose on you far to[o] much. I understand it costs a lot to hire and pay for all that you have done for me and do for me. I know I owe you rent since December [for storage]. I owe you for money expensed on the van, I owe you for time spent on my behalf… Perhaps when you get time, you can put down on paper how much I do owe you and as estimate of what I will yet owe to get all finished and then we can establish a repayment agreement that works for us both so there will be no upset feelings on either side.
19. Further emails dated 30 June 2015, 5 July and 7 July 2015, from Patient B to her employers, concerning a dispute with them, are copied to Mr Wardle as an additional recipient. In other email correspondence to a real estate agent from Patient B in January 2016 (and cc'd to Mr Wardle) concerning the lease for the joint business, she restates advice provided by Mr Wardle to her in an earlier email as coming from 'our financial advisor and attorney'.
20. Nothing in these emails, or the tenor of the evidence as a whole, supports Mr Wardle's contention that he was in an arms-length business relationship with Patient B. Rather, she was heavily reliant upon him and deferred to him in a range of financial and personal matters. It is also apparent that over time Mr Wardle presented Patient B with a series of 'invoices', which were in fact simply handwritten demands for money, not all of which Patient B understood the basis for, and not all of which reflected any prior agreement (such as when Mr Wardle unilaterally and retrospectively increased the amount he charged Patient B for storage of her goods).
21. Patient B stated that she jointly applied for residential premises with Mr Wardle in March 2015 under pressure from him. Conversely, Mr Wardle stated that he applied for the property as a 'gentlemanly gesture' or favour to Patient B, and that he deliberately understated his income in supporting documentation in order to trigger a rejection from the agent and avoid having to move in.
22. On balance we prefer the account given by Patient B. This because the tenancy application in evidence appears to actually overstate Mr Wardle's income and employment history (which is recorded by him as a 'full time' psychologist business when his oral evidence was that he had not worked full time since 1996) and the fact that at that juncture it was Mr Wardle and not Patient B who lacked residential premises. Particular 3.6(a) is made out.
23. Dr Keogh states, The reason why the 'Code' has clauses devoted to issues of client welfare post-termination is that it is widely recognized that the power differential in the relationship can continue to impact on the perception of the psychologist [by the former patient], post termination. This is more particularly the case with vulnerable personalities.
24. Although the tenancy application was not ultimately successful, Dr Keogh was strongly critical of the practitioner for contemplating such an arrangement. Given the respondent's continual reliance on the absence of express, specifically worded proscriptions to justify many of his actions, it is worth quoting the peer expert's view on this issue at some length. While there is nothing prescriptive in the 'Code' concerning living arrangements with ex-clients the fact that statements are made about a two-year interval between termination and the establishment of any sexual relationship is an indication that there is a caution that needs to be applied when contemplating such intimate arrangements with someone with whom there has been a therapeutic relationship. This is because there is considered to be a power imbalance in such a relationship (sometimes discussed in terms of the transference the client develops with a therapist) which means that there needs to be a period of time for the client to resolve such feelings which might otherwise interfere with her ability to make objective decisions about entering into such relationships. Given this, it would seem that to …[consider entering] into a residential tenancy agreement within four months of termination with an ex-client, especially without any consultation with a senior colleague, would suggest that such power imbalance issues have not been seriously contemplated and that the client in such a situation may be at risk of exploitation.
25. Dr Keogh's strong criticism concerning the later period in which Patient B resided in Mr Wardle's premises was based upon similar considerations. Dr Keogh notes that on Mr Wardle's account, this latter situation arose after Patient B was dismissed from a job in which she was also provided accommodation. He adds that Even if Mr Wardle's actions in proposing such a living arrangement were as he conveys intended to be kindly, they appear to represent very poor professional judgment and understanding of the client's mental health issues. …Mr Wardle's conduct in living with [Patient B] from August 2015 to January 2016 indicates a lack of professional acumen and clinical judgement and perhaps even an adequate understanding of the spirit of the 'Code' in regards to post termination relationships with ex-clients.
26. We concur in these criticisms.
27. In closing submissions Mr Wardle suggested that allowing Patient B to move into his residence in 2015 was in fact part of his ongoing provision of professional care, given that homelessness is a pre-determinant of poor mental health, and so this action should be seen as in accordance with his obligations under the Code and not as a breach. This belated argument was a wild reconstruction of events that is not in accord with any of the evidence, and accordingly we reject it. Particulars 3.6(b) and (c) are made out.
28. Mr Wardle's position was that there were no boundary transgressions with Patient B because there is no specific provision in the Code to prohibit a business relationship with a former patient. In his letter of 9 December 2016 to the Council he states that he is 'being punished for, without any ulterior motive or hope of gain, genuinely trying to help someone'. We reject this characterisation of the practitioner's conduct and find to the contrary that his actions were done with ulterior motive and hope of personal gain. Among other things it is hard to imagine how Patient B working without remuneration for the practitioner was something that was in her interests rather than his. Particular 3.7 is made out.
29. The peer expert was strongly critical of the financial and business dealings between the practitioner and Patient B on the basis that these did not reflect reasonable steps to safeguard the ongoing welfare of a former client, to avoid financial arrangements which may adversely influence the psychological services provided, and to avoid exploitation under the Code. We concur in these criticisms.
30. We reject the practitioner's efforts to rely upon ethical guidelines concerning practice in rural and remote settings to justify his conduct. Such guidelines concern the lack of anonymity and unavoidable multiple relationships and potential boundary crossings that may arise as a result of working life in a small community. These provisions are irrelevant to the case at hand because there was nothing inadvertent or unavoidable about the boundary crossings and multiple relationships Mr Wardle engaged in, they were at his behest and he took no steps to avoid them, minimise their impact, or seek supervision or guidance, for either himself or the patients, on how to manage them.
31. We find that Patient B was heavily reliant upon Mr Wardle throughout their enmeshed personal and business relationship and that his continuation of those relationships was exploitative in the extreme.
32. There are elements of Complaint 3 in which the practitioner's and Patient B's accounts are diametrically opposed: these concern whether he spoke to and touched her inappropriately. Some of these claims arise for the first time from Patient B's second statement made in January 2018, some two to three and a half years after the events.
33. Patient B gave oral evidence in a direct manner. She readily conceded that her recollection of events was not strong and that she did not remember a number of incidents or details clearly.
34. Mr Wardle's oral evidence, like his written reply to the complaint and extensive earlier correspondence with the HCCC and the Council, was combative, evasive, minimising of his own responsibility, and excessively focused upon challenging minor peripheral detail and technical issues (such as spelling mistakes made in expert reports, arguing that sharing residential accommodation was not 'living together' and so on).
35. There were a number of occasions in Mr Wardle's oral evidence in which he gave an account of a matter for the first time that was either unsupported or contradicted by contemporaneous emails and other documents in the evidence. Examples of particular concern are addressed in the following paragraphs.
36. In her first statement in 2016 Patient B claimed that on several occasions Mr Wardle 'arranged for his patients to assist us at the shop' and named three male patients, L, J and D. She also noted that she and Mr Wardle were jointly invited by J to his wedding in October 2015.
37. Mr Wardle claimed in oral evidence that he had attended the wedding of J in a professional capacity in order to support him concerning his anxiety about being married in a public event. However Mr Wardle did not recollect charging a fee for this service, making any clinical notes concerning it, nor seeing J as a patient subsequently. The invitation to the wedding was in evidence and was addressed in handwriting by first names to Mr Wardle and Patient B jointly. On balance we find that this was a social occasion - involving not one but two former patients - and this substantiates particular 3.6(g).
38. In oral evidence Mr Wardle stated that he had provided L with Patient B's details while L was a current patient (and Patient B a former patient). He said that he had done this because L was unemployed and Patient B needed assistance with a computer task in her business; he did so in order to help L out, and knew no more about it. Under cross examination and questioning from the Tribunal, it became apparent that this was at best a highly disingenuous and self-serving account. Email records showed that Mr Wardle had in fact passed L's contact details onto Patient B after a discussion with Patient B about the task. The task was one that served the joint business which Mr Wardle was conducting at the time with Patient B.
39. In oral evidence Mr Wardle stated that D, while a current patient, had responded to an advertisement placed by Patient B and turned up for an interview at the joint business premises at a time when Mr Wardle also happened to be present. Mr Wardle had then taken D aside and explained to him that it would be inappropriate for him to work there because of the dual relationship, such that D had never taken up employment at the business. This account runs contrary to email correspondence from Patient B to Mr Wardle on 19 February 2016 which states, D worked from 10.15 to 11.30 said he had school work and couldn't work anymore yesterday - also he didn't think he could work Friday through Sunday - I said you had impression he would/could work and he said would get a hold of you.
40. When Mr Wardle was asked at the first s 150 proceeding in 2016 whether he had 'any other previous clients' that he had developed friendships with or had other relationships with outside of psychology he answered by saying, 'There was one years ago, years ago, that I bumped into and that was more than two years after…' and denied any other dual relationships with current or former clients. In response to a question from the Tribunal, Mr Wardle stated that he did not believe that failing to mention J, L and D meant that this was a misleading or dishonest answer.
41. In oral evidence Mr Wardle claimed for the first time that he had in fact sent reports to Patient B's GP via email, although he had no computer copy and no email copy of those reports or correspondence. When asked if he had contacted the GP in an attempt to locate a copy, having received notice that this was an issue in the complaints and found that he had no copies himself, the respondent said no, he had not sought any duplicate copy because his word alone should be enough. Likewise, Mr Wardle claimed for the first time in oral evidence that he had in fact made a reconstruction of Patient B's clinical notes, which he had not produced or brought with him to the hearing despite knowing that this was in issue. We reject the respondent's account of these matters and find that particulars 4.2 and 4.1(b) are made out.
42. On the basis of the above, in addition to other matters such as the practitioner's self-serving reconstruction of the termination decisions, we place limited reliance on Mr Wardle's credibility. We generally prefer the evidence of Patient B concerning contested issues.
43. Mr Wardle denied particular 3.6(e) which was that he had used Patient B's personal mailbox and 'refused to return the keys' prior to Patient B changing the lock. This was said to be because, although he had the key and retained it, he had 'never been asked' to return it. Mr Wardle did not concede any impropriety in his having access to a former patient's personal mail. This denial typified the practitioner's literalistic, minutiae-focused, response to the complaint as a whole. On the basis of our preference for Patient B's account, this particular is made out.
44. The Tribunal faced some challenges in making determinations on a number of contested particulars which were expressed in a very general manner and which were based upon a broad or undetailed recollection of Patient B within a wide time period and recorded after a lengthy passage of time. For example, the particular that Mr Wardle had over a period of 6 months during the therapeutic relationship 'on more than one occasion' tucked his shirt in with his hand moving over his crotch. This meant that there were some matters on which we could not be satisfied on the balance of probabilities. We stress that these do not involve a finding that we disbelieve Patient B, nor that we believe Mr Wardle in preference; rather that there is simply insufficient evidence to allow us to prefer one account over the other after the passage of time, and so we cannot be satisfied that the particular is proved on the balance of probabilities.
45. The above conclusions apply to particulars 3.1(a)(b)(c)(iii), (iv), (d) and (e), concerning Mr Wardle's alleged sexualised conduct within the therapeutic sessions, which are not found proved to the Briginshaw standard.
46. In instances in which Patient B's evidence was detailed and internally consistent and/or corroborated by other sources, it is accepted over the practitioner's contrary account and denials. On this basis we find that particulars 3.1(c)(i) and (ii) are made out, concerning Mr Wardle's inappropriate personal disclosures during the therapeutic sessions. This is based on our acceptance of Patient B's account of the developing 'friendship' and inappropriate personal disclosures on behalf of the practitioner that occurred during the therapeutic relationship, and the contemporaneous record of the same matter in (ii) in clinical records kept by Mr Wardle's treating psychiatrist.
47. We reject Mr Wardle's account that he had never visited Patient B's home during the course of the therapeutic relationship. On the basis of the consistency between Patient B's 2016 and 2018 accounts, and her recollection of details of the gifts proffered by the respondent under cross examination, as well as other details such as incidents involving Mr Wardle's dogs, we accept her account as credible and find that all of particular 3.2, concerning conduct at Patient B's home during the time of the therapeutic relationship, is made out with the exception of (vi) and (xi). These latter two sub-particulars are of physical contact which would, in another context, be labelled alleged indecent assault. Given the very general nature of the Patient's recollection and the long time period over which it could have occurred, we are not able to make a finding that these sub-particulars are proved to the Briginshaw standard.
48. On the basis of the consistency between Patient B's 2016 and 2018 accounts, we find that particular 3.6(d), concerning the conduct of Mr Wardle while Patient B was living in premises with him, is made out with the exception of (i) and (iv). Sub-particular (i) is that sometime in that 23 week period Mr Wardle 'made verbal sexual innuendos'. With respect this pre-judges a conclusion by such framing and provides no content to the verbal acts. We are unable to make a finding upon it. Sub-particular (iv) concerns Mr Wardle entering Patient B's room without knocking. The generality of the claim and long time period leaves us unable to make a finding on balance.
49. Taken together, the proved contested conduct in Complaint 3, including personal contact and gifts during the therapeutic relationship and various incidents of sexualised remarks and touching thereafter, amount to conduct that is both reasonably below the standard expected and improper and unethical. This conduct, if taken alone, would be sufficiently serious as to rise to the level of professional misconduct. In tandem with the findings on the other complaints, Complaint 5 of misconduct is very comfortably made out.
50. In sum, the admitted and proved matters from the complaints represent a pattern of conduct involving endemic boundary crossings and violations over a prolonged period.
51. Looking at the conduct as a whole, the Tribunal is gravely concerned about the competence and fitness to practise of a psychologist who not only undertook such conduct but who regarded, and still regards, the bulk of it as acceptable practice, as not raising any ethical issues, and as not requiring the advice and assistance of a more senior colleague.

Impairment

1. Dr Samuels provided an assessment of Mr Wardle dated 12 April 2017 based upon a review of much of the investigation material, various medical records concerning Mr Wardle and an in person assessment. At that time Dr Samuels' opinion was that Mr Wardle had a serious mood disorder which 'seems to be in remission'. He also expressed concern that Mr Wardle has 'some underlying personality vulnerability with marked narcissistic personality features.' In Dr Samuels' view the mood disorder could potentially impact upon Mr Wardle's capacity to practise if it became severe again, 'and there is certainly evidence that the narcissistic aspect of his personality has impacted upon his judgement and behaviour' in relation to Patient A and B. At that time, Dr Samuels regarded Mr Wardle as having an impairment within the meaning of the National Law.
2. The Council directed Mr Wardle to return to Dr Samuels in September 2019 in order to provide a more recent health assessment for the purpose of these proceedings, but Mr Wardle refused to do so.
3. Mr Wardle's position at the hearing was that he does not have a major depressive disorder, rather that he has in the past experienced depressive symptoms as a consequence of a serious sleep disorder and/or immune disorder. That is, depression is a symptom not a cause. Moreover his 'supposed depressive disorder, sleep disorder and immune system disorder are extremely well managed and there is no subsequent impairment'. Although he has not consulted with his psychiatrist for the past four years, he still regards her as his treating psychiatrist and his condition as treated by her. He is on anti-depressant medication prescribed by a GP. Mr Wardle disputes that he has a personality disorder.
4. Ms de Bakker has supervised the respondent since May 2018, at first fortnightly and then monthly. In a letter dated 17 July 2019 she stated that 'Mr Wardle is fit to perform his role and duties as a Psychologist'. In her oral evidence, Ms de Bakker clarified that she has never clinically assessed or treated Mr Wardle, and that the sole focus of her supervision sessions with him has been professional boundaries.
5. Ms de Bakker was provided with the opportunity to comment upon Dr Samuels' report. In her view a mood disorder in remission should not lead to a conclusion of impairment if there is no evidence of current symptoms. When asked to comment on Dr Samuels' opinion regarded narcissistic traits, Ms de Bakker stated that she did not agree with this view, particularly as she did not see the respondent as lacking in empathy or grandiose, but could see how Dr Samuels could come to such a conclusion given Mr Wardle's propensity for challenging other people's views, his preference for his own interpretations and his non adherence to the views or rules of others.
6. In cross examination Mr Wardle challenged Dr Samuels' opinion as based upon Patient B's account of events, which he contended was false. Dr Samuels' response was that his assessment of the practitioner was that he had 'extremely poor' judgement in relation to boundaries and that this assessment was not based on the veracity of the complaints but upon the practitioner's own account.
7. Having read Mr Wardle's September 2019 reply to the complaint, Dr Samuels expressed the view that what he had referred to as a personality vulnerability was 'more in line with a frank personality disorder'. When pressed by the respondent, Dr Samuels expressed the view that this meant that Mr Wardle met five or more of the nine criteria for narcissistic personality disorder in the Diagnostic and Statistical Manual (DSM).
8. In the course of cross examination the respondent asked Dr Samuels to identify the relevant criteria which informed this judgment. Dr Samuels expressed the view that, based upon his observations of Mr Wardle and the material he had seen, Mr Wardle met the following criteria: grandiose, believed himself to be special and above the rules, required admiration, took advantage of others to achieve his own ends, lacked empathy and was arrogant. In Dr Samuels' opinion Mr Wardle lacked empathy 'to a very concerning degree.'
9. On balance, the Tribunal prefers Dr Samuels' opinion to that given by Ms de Bakker. This is because Ms de Bakker has not assessed Mr Wardle in a clinical sense and was not apprised of Mr Wardle's written material and because, as discussed below, the Tribunal's own assessment was in accord with that of Dr Samuels.
10. Mr Wardle vigorously contested the notion that he had ever suffered from depression. He claimed that his former psychiatrist had told him that he was 'psychologically the healthiest person she'd ever met.' We mean no disrespect to Mr Wardle when we note that there is nothing in this psychiatrist's voluminous clinical records, over a 12 year period, to substantiate such a view. The only reasonable conclusion which can be drawn from such records, which include a number of referrals by different medical practitioners for treatment for depression, which included two courses of ECT, is that the practitioner has suffered from major depression in the past.
11. We accept the practitioner's submission that a properly managed mood disorder is not in itself an impairment if there is no reason to conclude that it might detrimentally affect capacity to practise.
12. At the hearing Dr Samuels expressed the view that the practitioner had 'a mood disorder of some severity' but that he did not have sufficient recent information to form an opinion of whether this affected Mr Wardle's current functioning.
13. Mr Wardle's submission was that he had experienced a number of challenging personal circumstances in recent years and had not suffered depression in that context. Mr Wardle states that he continues to take anti-depressant medication. It is of some concern that Mr Wardle has not consulted his 'treating psychiatrist' for over four years and does not have any mental health professional currently managing his condition. Thus although the major depressive episodes which Mr Wardle suffered are now many years in the past, it is hard to categorise his condition as well managed.
14. The Tribunal is not required to specify precisely what mental illness or disorder a respondent suffers from in making a finding of impairment: Grant v HCCC [2003] NSWCA 73; Qasim v Health Care Complaints Commission [2015] NSWCA 282.
15. As a tribunal constituted with specialist expertise, the Tribunal is entitled to inform itself during the course of proceedings in forming a view of the respondent's potential impairment and of the expert's assessment of that potential impairment, providing that is done in a procedurally fair manner: Qasim v Health Care Complaints Commission [2015] NSWCA 282. Mr Wardle was alerted at the outset of the hearing that this could occur.
16. Any tribunal, even a specialist tribunal, should be slow to construe a self-represented respondent's demeanour (which is liable to be at best, highly stressed and at worst, somewhat disorderly) and their conduct of their case (in which complaints are entitled to be tested, even vigorously contested) as evidence that he or she suffers from an impairment. The disciplinary hearing is a unique adverse event in the lives of most health practitioners who appear within it, involving unique stressors, and encompassing behavioural expectations that are familiar to everyone else in the room except the respondent.
17. Even applying the above caution, we are led to the unavoidable conclusion, based upon all of the evidence, including the practitioner's multiple letters and replies to the HCCC and Council over the three year period from 2016 to 2019, the expert assessment by Dr Samuels, and Mr Wardle's oral evidence as well as his presentation in the hearing room over five days, that the practitioner does suffer from a severe personality disorder. We find that this disorder detrimentally affects Mr Wardle's capacity to practise and is an impairment within the meaning of the National Law.
18. It was striking that Mr Wardle appeared unable to ever admit himself to be in the wrong. Even concerning the admitted conduct with Patient A and B he expressed himself as having been 'on the line', not as having crossed an ethical line or transgressed a boundary.
19. Mr Wardle appeared unable to ever defer to or accept the professional judgment of others when it differed to his own. For example, in answer to the suggestion that he failed to manage the terminations appropriately by not seeking advice from a senior colleague, his response was that he would only seek advice or input from a colleague if he was 'uncertain' or 'had doubts', and that as he wasn't uncertain in either situation, he didn't need to. Another example was that Mr Wardle argued that Dr Samuels lacked the expertise to diagnose him with a personality disorder because Dr Samuels is 'really' a 'prison psychiatrist' and had drawn upon the wording of criteria used in an earlier version of the DSM. Dr Samuels' extensive professional CV as a forensic psychiatrist with particular expertise in the impairment of health professionals was in evidence. At the same time, Mr Wardle, with quite limited practice experience as a psychologist, purported to diagnose Patient B (some years post-treatment) with 'the most extreme case of Narcissistic Personality Disorder that I have ever come across and fits all ten diagnostic criteria/reported behaviours.' At the same time Mr Wardle did not accept that Patient B was a vulnerable patient.
20. In oral evidence, and in his cross examination of the peer expert and Dr Samuels, Mr Wardle repeatedly claimed that 'patients are not vulnerable 100% of the time', that there is 'always an exception', and even that some patients in fact hold 'power superiority' in the therapeutic relationship. Mr Wardle claimed that in each situation he was able to make an assessment for himself of what was appropriate, such that the ethical guidelines, or peer expert opinion, simply did not apply to what he had done. We have reached the unavoidable conclusion that Mr Wardle's understanding is that it is he who is the exception to the rule.
21. In both opening and closing submissions, Mr Wardle quoted from a text to the effect that professional boundaries limit the ability of health professionals to provide empathy and kindness. In opening Mr Wardle stated, 'I will admit to being guilty of providing kindness' and 'I am appalled that after offering so much kindness it has been thrown back in my face.' Mr Wardle stated in closing, 'I now know that I need to be less kind in order to continue in this profession. I accept that as my legal obligation.' The practitioner appeared genuinely unable to comprehend the vital role that professional boundaries and ethical guidelines play in protecting patients, or the harm and potential harm that he had exposed Patients A and B (and, for that matter, J, L and D) to in pursuing multiple relationships with them.
22. We conclude that the practitioner's professional judgment is profoundly impaired by a personality disorder and that this has a major detrimental impact upon his capacity to practise. Complaint 6 is established.
23. Based upon our findings, a Stage 2 hearing is required to consider the appropriate protective orders. Directions are made below to allow this to occur at a one day hearing as soon as practicable. The respondent is reminded of the importance of providing any material in advance to the Tribunal and to the HCCC, so that procedural fairness can be afforded to both parties and the hearing is able to run effectively.
24. To assist the respondent we note that any health assessment and professional or personal references which he proposes to tender may involve the HCCC requiring the person making the statement or report to be made available for cross examination at the hearing.
25. We also note for the assistance of the respondent that references and other forms of opinion evidence are generally given more weight in Stage 2 proceedings when it is clear that the person making the statement has knowledge of the particulars of the complaints and/or has read the Stage 1 reasons.

Orders 1. Pursuant to findings of unsatisfactory professional conduct, professional misconduct and impairment, a second stage hearing on protective orders is directed. 2. The parties are to communicate with the registry to set a date for a one day Stage 2 hearing. 3. The HCCC is to file and serve any further evidence and submissions concerning Stage 2 by 13 December 2019. 4. The respondent is to file and serve any further evidence and submissions by 31 January 2020. 5. HCCC to file and serve a reply if any by 7 February 2020. 6. The parties are reminded that the above material is to address the issue of appropriate protective orders only. 7. Any material that is not filed in accordance with these directions will not be admitted in the absence of compelling justification. 8. Leave to the parties to relist for directions with three days' notice. 9. Costs of proceedings reserved. 10. Pursuant to s 64 of the Civil and Administrative Tribunal Act 2013 (NSW) prohibition of disclosure or publication of the names of Patients A and B listed in the schedule to the complaint, and of all other patients identified in the evidence.

I hereby certify that this is a true and accurate record of the reasons for decision of the Civil and Administrative Tribunal of New South Wales. Registrar DISCLAIMER - Every effort has been made to comply with suppression orders or statutory provisions prohibiting publication that may apply to this judgment or decision. The onus remains on any person using material in the judgment or decision to ensure that the intended use of that material does not breach any such order or provision. Further enquiries may be directed to the Registry of the Court or Tribunal in which it was generated. Decision last updated: 05 November 2019